We understand the importance of your Protected Health Information (hereafter referred to as “PHI”) and
follow strict policies (in accordance with state and federal privacy laws) to keep your PHI private. PHI
is information about you, including demographic data, that can reasonably be used to identify you and
that relates to your past, present or future physical or mental health, the provision of health care to you,
or the payment for that care.

In this notice, we explain how we protect the privacy of your PHI, and how we will allow it to be used and
given out (“disclosed”). We are required to provide you with a summary of our Notice of Privacy Practices,
and a copy of the Notice of Privacy Practices upon request. We must follow the privacy practices described
in this notice while it is in effect.

We reserve the right to change our privacy practices and the terms of this notice at any time, provided that
applicable law permits such changes. These revised practices will apply to your PHI regardless of when it
was created or received. Before we make a material change to our privacy practices, we will provide you with
a revised Notice of Privacy Practices.

Where multiple state or federal laws protect the privacy of your PHI, we will follow the requirements that
provide the greatest privacy protection. For example, when you authorize disclosure to a third party, state
law requires us to condition the disclosure on the recipient’s promise to obtain your written permission to
disclose to someone else.

Our Uses and Disclosures of Protected Health Information

We do not sell your PHI to anyone or disclose your PHI to other companies who may want to sell their
products to you.

We must have your written authorization to use and disclose your PHI, except for the following uses and
disclosures:

To You:

We may disclose your PHI to you, for example:

Supplying you with information about your diagnosis or treatment.

Communicating with you about treatment alternatives or other health-related benefits and services.

For Treatment:

We may use and disclose your PHI to health care providers and our business associates who request PHI
in connection with your diagnosis, treatment, management of your care, coordination of benefits, and
insurance eligibility, for Example:

Physicians and physician’s assistants

Nurses

Dentists

Audiologists

Speech-language pathologists

Physical or occupational therapists

Psychologists

Pharmacies

Hospitals

Nursing homes

Hearing instrument manufacturers

Augmentative communication device manufacturers

For example, we may disclose your PHI to health care providers in connection with:

Disease and case management programs

Prescribing medications

Ordering lab work or diagnostic imaging at an outside facility

Referring you to an outside provider and informing him/her of your medication allergies

Providing emergency medical treatment

Orders and service for hearing instruments and augmentative communication devices

Performing business management and other general administrative activities,
including systems management and member service

Scheduling appointments and keeping records

We may also disclose your PHI to other providers and health plans who have a relationship with you
for their health care operations. For example, we may disclose your PHI for their quality assessment
and improvement activities or for health care fraud and abuse detection.

To Others Involved in Your Care:

We may disclose your PHI to someone who has the legal right to act on your behalf. We may under certain
circumstances disclose to a designated contact person (e.g., a member of your family, a relative, a close
friend or any other person you identify), the PHI directly relevant to that person’s involvement in or
payment for your health care. For example, we may discuss a claim determination with you in the presence
of a friend or relative, unless you object.

When Required by Law:

We will use and disclose your PHI if we are required to do so by law. For example,
we will use and disclose your PHI:

To report infectious diseases

To respond to court and administrative orders and subpoenas

To comply with workers’ compensation laws

To report congenital hearing losses in infants and children

To report occupational noise induced hearing loss

To report suspected abuse and neglect to the proper authorities

To report PHI as required by the Centers for Medicare and Medicaid Services (CMS) and state regulatory authorities

For Matters in the Public Interest:

We may use or disclose your PHI without your written permission for matters in the public
interest, including for example:

Public health and safety activities, including Food and Drug Administration oversight,
reporting disease and vital statistics.

Averting a serious threat to the health or safety of others,
(e.g., as required under the Patriot Act

For Research:

We may use your PHI to perform select research activities, provided that certain established measures
to protect your privacy are in place, as required by Institutional Review Board regulations created and
monitored by the National Institutes of Health.

To Our Business Associates:

From time to time we engage third parties to provide various services for us. Whenever an arrangement
with such a third party involves the use or disclosure of your PHI, we will have a written contract with
that third party designed to protect the privacy of your PHI. For example, we may share your information
with business associates who process claims or conduct disease management programs on our behalf.

Disclosures You May Request

You may instruct us and give your written authorization to disclose your PHI to a designated individual
or agency for any purpose. We require that your authorization be on our standard form. To obtain the form,
you can contact us in writing or by calling the Ultimate Health Plans Member Services Department. The
address and telephone number is:

Toll free 1-888-657-4170. TTY call 711. Hours of Operation 8 a.m. - 8 p.m., local time, 7 days a week.
From February 15th through September 30th, alternate technologies (for example, voicemail) will be used
on the weekends and holidays.

Individual Rights

You have the following rights. To exercise these rights, you must make a written request on our standard
form. To obtain the form, contact us either in writing or by telephone as indicated above. We must act upon
your written request within 60 days.

Access: With certain exceptions, you have the right to look at or receive a copy of your PHI
contained in the group of records that are used by or for us to make decisions about you, including our
enrollment, payment, claims adjudication, and case or medical management notes. We reserve the right to
charge a reasonable cost-based fee for copying and postage. If you request an alternative format, such
as a summary, we may charge a cost-based fee for preparing the summary. If we deny your request for access,
we will tell you the basis for our decision and whether you have a right to further review. You may request
access to PHI in an alternative communication format and/or location.

Disclosure Accounting You have the right to an accounting of certain disclosures of your PHI, such
as disclosures required by law. If you request this accounting more than once in a 12-month period, we may
charge you a fee covering the cost of responding to these additional requests.

Restriction Requests: You have the right to request that we place restrictions on the way we use
or disclose your PHI for treatment, payment or health care operations. We are not required to agree to these
additional restrictions; but if we do, we will abide by them (except as needed for emergency treatment or
as required by law) unless we notify you that we are terminating our agreement.

Revoke Prior Authorization: You may revoke your authorization, except to the extent that we
have taken action upon it.

Amendment: You have the right to inspect PHI and request that we amend it in the set of records
we described above under Access. If we deny your request, we will provide you a written explanation. If
you disagree, you may have a statement or your disagreement placed in our records. If we accept your request
to amend the information, we will make reasonable efforts to inform others of the amendment, including
individuals you name.

Confidential Communication: We communicate decisions related to payment and benefits, which may
contain PHI, to the member or the member’s authorized representative. Individual members who believe that
this practice may endanger them may request that we communicate with them using a reasonable alternative
means or location. For example, an individual member may request that we send an Explanation of Benefits
to a post office box instead of the home address. To request confidential communications, contact us in
writing or by telephone as indicated above.

Questions and Complaints

If you need more information about our privacy practices, or a written copy of this notice, please contact us at:

Toll free 1-888-657-4170. TTY call 711. Hours of Operation 8 a.m. - 8 p.m., local time, 7 days a week. From February
15th through September 30th, alternate technologies (for example, voicemail) will be used on the weekends and holidays.

If you are concerned that we may have violated your privacy rights, or you believe that we have inappropriately used
or disclosed your PHI, please contact:

Toll free 1-866-657-4170. TTY call 711. Hours of Operation 8 a.m. - 8 p.m., local time, 7 days a week. From
February 15th through September 30th, alternate technologies (for example, voicemail) will be used on the weekends
and holidays.

Toll free 1-866-657-4170. TTY call 711. Hours of Operation 8 a.m. - 8 p.m., local time, 7 days a week. From
February 15th through September 30th, alternate technologies (for example, voicemail) will be used on the weekends
and holidays.

We support your right to protect the privacy of your PHI. We will not take action against you if you file a
complaint with us or with the U.S. Department of Health and Human Services, the Centers for Medicare and Medicaid
Services (CMS) or other state or federal agency or organization.

For a summary of our Privacy Practices describing how medical information about you may be used and disclosed and how
you can get access to this information please click on the link below.

Ultimate Health Plans is an HMO plan with a Medicare contract. Enrollment in Ultimate Health Plans depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Medicare beneficiaries may also enroll in Ultimate Health Plans through the CMS Medicare Online Enrollment Center located at www.medicare.gov. Ultimate Health Plans does not collect any member information through this website.